Helen Hayes Hospital
Route 9W, West Haverstraw
NY 10993
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Patient Forms

The following forms are provided as fillable PDFs. You may download the form, fill it out on your computer, save, and email the form back to Helen Hayes Hospital. Alternatively, you may print these forms, scan or take a picture of the completed form, and email the form back to the appropriate contact at the hospital.


Outpatient Therapy Forms: please email the following forms to